Permit Request Form
 



 

 

1.   Location    (Must supply valid physical address to be processed)
 
2.   Nature of Work   
(Indicate below all items to be affected/disturbed and include information on drawing of plan or work to be done)




 
3.   Method of Installation
(attach detailed description/sketch of intendedwork) valid formats: pdf, doc, jpg, dwg, dwf


# Feet:     Bore Pits: 
# Feet:      Street:   Blvd: 
Size Feet: Street:  Blvd:
 
 
4.   Work to start date:         Completion date:    
 
5.   Will lane closure or traffic detouring be necessary?
Notification must be given 3 days prior to closure to alert city works and transportation.  Upon approval closure may be implemented.
 
Local Representative performing work
Name: Phone:
Email: Fax:
Address:
Emergency after hours contact (24 hrs):   
 
Part or Organization work being performed for
Name: Phone:
Address:
Issue Permit to:
Applicant shall contact the City of Moorhead for all required inspections and upon completion of work.

Date: 11/23/2008